Pathology of the Male Genital System

THE PENIS Malformations of the Penis Hypospadias is the most common malformation (1 in 250 live male births). It refers to the abnormal location of the distal urethral orifice along the ventral aspect of the penis. The urethral orifice is sometimes constricted, resulting in urinary tract obstruction. Epispadias: the urethral orifice is situated on the dorsal aspect of the penis. Like hypospadias, epispadias may produce lower urinary tract obstruction or incontinence. Inflammatory Lesions of the penis Balanitis refer to local inflammation of the glans penis; it may be associated with inflammation of the overlying prepuce. Most cases occur due to poor local hygiene in uncircumcised males, with accumulations of smegma (desquamated epithelial cells, sweat, and debris) that acts as a local irritant. The distal penis is typically red, swollen, and tender; a purulent discharge may be present. Phimosis refers to the difficulty of retracting the prepuce over the glans. It may be congenital but most cases are acquired from scarring of the prepuce secondary to previous balanitis. Genital candidiasis is particularly common in patients with diabetes mellitus. Candidiasis presents as a painful, intensely pruritic erosions involving the glans penis, scrotum, and adjacent intertriginous areas. Scrapings or biopsy specimens of the lesions reveal characteristic budding yeast forms & pseudohyphae within the superficial epidermis. Penile Neoplasms Squamous cell carcinomas of the penis are relatively uncommon. Most cases occur in uncircumcised patients older than 40 years of age. Etiological factors include poor hygiene that expose the area to potential carcinogens in smegma, smoking, and infection with human papillomavirus (HPV), particularly types 16 and 18. These carcinomas are generally preceded by dysplastic changes termed intraepithelial neoplasia that may culminate in carcinoma in situ. Clinical variants of carcinoma in situ, all strongly associated with HPV infection, occur on the penis 1. Bowen disease (Erythroplasia of Queyrat) a solitary, erythematous, plaque-like lesion on the shaft of the penis that displays microscopically malignant cells throughout the epidermis. It may progress to invasive carcinoma in one third of the cases. 2. Bowenoid papulosis presents as multiple reddish brown papules on the shaft, glans or scrotum; it is and most often transient, with only rare progression to carcinoma. Gross features of invasive Squamous cell carcinoma  This tumor appears as a gray, crusted, papular lesion, most commonly on the glans penis or prepuce.  In many cases, the carcinoma infiltrates the underlying connective tissue to produce an indurated, ulcerated lesion with irregular margins. Microscopic features  SCC is usually a keratinizing with infiltrating margins.  Verrucous carcinoma is very well differentiated variant of squamous cell carcinoma characterized by a papillary architecture & rounded, pushing margins.